AUTHOR=Zhang Binghui , Zhang Hongyang , Wu Yuan , Li Guofang , Liu Shuxiang , Zhao Kai 

TITLE=Effect of dural puncture epidural combined with programmed intermittent epidural bolus on labor analgesia in patients with gestational hypertension: a randomized controlled clinical trial

JOURNAL=Frontiers in Medicine

VOLUME=Volume 12 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1653301

DOI=10.3389/fmed.2025.1653301

ISSN=2296-858X

ABSTRACT=BackgroundHypertensive disorders of pregnancy affect 5–10% of pregnancies and require the maintenance of hemodynamic stability while providing effective labor analgesia. This study compared the efficacy and safety of dural puncture epidural (DPE) block combined with programmed intermittent epidural bolus (PIEB) versus conventional epidural (EP) block in labor analgesia for patients with gestational hypertension (GH).MethodsBetween January and March 2025, 98 primiparous women with GH and singleton pregnancies who requested neuraxial analgesia were randomized to receive either DPE–PIEB (Group D, n = 49) or EP–PIEB (Group E, n = 49). The primary outcome was time to effective analgesic onset (defined as Visual Analog Scale score≤30 mm). Secondary outcomes included hemodynamic stability, patient-controlled epidural analgesia (PCEA) use, incidence of breakthrough pain, maternal and infant outcomes, and adverse events.ResultsCompared with EP–PIEB, patients receiving DPE–PIEB had a shorter onset of analgesia (6.05 ± 1.08 vs. 9.75 ± 1.3 min, p < 0.001), a longer time to first PCEA request (144.33 ± 17.18 vs. 116.58 ± 14.03 min, p < 0.001), fewer PCEA demands (2.78 ± 0.83 vs. 4.53 ± 1.26, p < 0.001), and had a lower incidence of breakthrough pain (9.1% vs. 25%, p < 0.05). The repeated measures ANOVA demonstrated that patients in Group D maintained lower and more consistent Mean arterial pressure (MAP) values throughout labor. MAP values were significantly lower at time points T1, T3, T4, and T5 in the DPE–PIEB group (p < 0.05), and maternal satisfaction scores were higher (9.39 ± 0.75 vs. 9.02 ± 0.76, p < 0.05). No significant between-group differences were found in neonatal outcomes (Apgar score, umbilical artery pH) or the incidence of adverse events between the two groups (p > 0.05).ConclusionDPE–PIEB can significantly shorten the onset of labor analgesia in patients with GH, reduce hemodynamic fluctuations and breakthrough pain, and improve maternal satisfaction, without increasing maternal or neonatal risks. This combined technique provides a more optimized analgesic strategy and can be safely and effectively implemented in labor analgesia for patients with GH.Clinical trial registrationIdentifier ChiCTR2400095084 (www.chictr.org.cn).